Cerebral abscess following the self-extraction of teeth in patient with Ebstein’s anomaly: a case report

Abstract

Background Antibiotic prophylaxis before invasive treatments, including dental extractions, is still recommended for patients at high risk of infective endocarditis. However, the risk from self-extraction of teeth in daily life of patients with intellectual disabilities is uncertain. Case presentation A 6-year-old patient with Ebstein’s anomaly developed cerebral abscess, which appeared associated with infective endocarditis of dental origin. Two weeks after self-extraction of his deciduous teeth, he began to experience pain in his ear and developed continuous fever, followed by vomiting, facial spasm, and a loss of consciousness. He was admitted into a hospital for 2 months, during which he received intravenously administered antibiotics and a drainage tube in his brain. Conclusions Deciduous teeth can be self-extracted before root resorption and natural shedding in patients with intellectual disabilities. When they are at high risk of infective endocarditis and frequently touch mobile deciduous teeth, it seems to be an option to extract the teeth early with antibiotic prophylaxis, rather than to wait natural fall.

A rare case of multiple brain abscesses caused by apical periodontitis of deciduous teeth in congenital heart disease: a case report

“…Studies have shown that in cyanotic congenital heart diseases with right to left shunt, such as tetralogy of Fallot or functional single ventricle, venous blood may enter directly into the systemic circulation, thereby increasing the risk for developing brain abscesses [ 6 , 7 ]. Given that the patient had a cyanotic congenital heart disease with right to left shunt, we speculated that the patient developed multiple brain abscesses caused by apical periodontitis of deciduous teeth.…”

Dental Infections and Risk for Brain Abscess: A Literature Review

“…Streptococcus viridans have been demonstrated to cause brain abscess in patients with infected pulp [11]. One descriptive and comparative metagenomic study showed how there was a 65.5% overlap between microorganism species of empyemas and brain abscesses, with Streptococcus intermedius, Fusobacterium nucleatum and Aggregatibacter aphrophilus being the most common pathogens [12].…”

“…The risk of surgical procedures within the skull includes the possibility of introducing other pathogens, which may respond to different antibiotic treatments and require alternative subsequent management. Thus, the neurosurgical drainage approach is only added to the antibiotic treatment when there is sufficient size of tumor to use more than antibiotics, due to the risk the procedure itself can present [12,25].…”

“…This is most likely attributed to the middle meningeal artery transportation of the bacteria to the brain being the most likely route of bacterial flow, with posterior communicating artery being the less likely alternate route of travel. Along with the frontal and temporal lobes being physically closer to the nasopharynx and oral cavity.Brain abscess due to dental infections may be predisposed in certain patients with preexisting conditions such as right-to-left shunts that can be seen in a PFO, thoracic venous anomalies, Ebstein's anomaly, and venosus atrial septal defects[12,34,[36][37]. Dental procedures, such as dental scaling, done to these vulnerable patients can increase the risk of a brain abscess due to veno-arterial seeding.Odontogenic brain abscesses may include extra intermediate steps as the bacteria spreads from the oral cavity, such as sinusitis.…”